Xpress Refill Registration
Mabuhay! Thank you for your interest in accessing treatment via the Xpress Refill service.

In this service, you will be able to receive your ARV refill via delivery. No need to go to your LoveYourself community center. Receive your medication at your time of convenience.

*If you have previously signed up in the same link (go.loveyourself.ph/xpressrefill) within the last few days, you don't have to signup again as we are COLLECTING ALL responses.

*If you have 14-days or less worth of pills, we strongly advise that you call instead our emergency refill hotlines. This service may incur some delays due to the community quarantine in effect and uncertainties in the operations of courier services. Rest assured, we will using all delivery channels available to us.
Email address *
Taking ARVs regularly and consistently helps you achieve Undetectable Viral Load
Faster 2-Step Process
There are 3 steps you need to follow to receive your ARV supply.

Step 1. Sign up: Give your details in this online form. Within 48 hours, we will contact you via SMS and/or call.

Step 2. ARV Delivery: We will send your ARV resupply within 24 hours at your preferred location. For the moment, we have identified that Lalamove, Angkas (Delivery) & Grab Express are our best options. We can book the delivery and you can pay at delivery. No need to send payment to us. Everyone will receive one (1) bottle of their ARV regimen.

If we are unable to reach you at your current location, we will call and give further advice on where to access your medication

*Please take note that the above process may be subject to change without prior notice as we respond to the developing situation, and as we assess how we can serve all clients better continuously
Client Code *
Example: If you were enrolled in 2019, your code is something like TLY19-1234. The letters change according to your center e.g. VLY for Victoria. You may be most familiar with the last four digits.
Your answer
Your birthdate? *
MM
/
DD
/
YYYY
What Region are you in now? *
Full Delivery address (Unit, Bldg, Street, Brgy, City, Zip Code) *
This is the delivery address where your ARV will be delivered. Make sure that the address is accurate and complete. Include the ZIP Code.
Your answer
Zip Code & Pickup
Search for your zip code at https://www.whatismyzip.com/
Contact Number *
Your answer
Your Community Center is *
How many DAYS worth of pills do you still have left? *
Your answer
How will be you able to afford Xpress Refill? *
Next
Never submit passwords through Google Forms.
This form was created inside of LoveYourself Inc.. Report Abuse